Discharge Instructions - Contract for Safety

Based on our clinical examination and testing, we feel that you are safe for discharge home today with the following precautions:

As discussed in the emergency department prior to discharge, you should be aware that worsening depression, thoughts of suicide with thoughts or images of specific plans, and behavior such as writing notes or giving away possessions are warning signs for risk of suicide.  If you experience these symptoms or have any concerns for your safety, you must return to the emergency department immediately, preferably by ambulance or with a friend or family member.

As discussed in the emergency department, you can attempt to distract yourself from depressive thoughts by engaging in healthy coping strategies, such as exercising, watching television or a movie, or contacting a friend, family member, or a chaplain or religious leader to talk.  You can obtain free and confidential support if you feel in distress or are having thoughts of suicide 24 hours a day 7 days a week by calling the National Suicide Prevention Hotline at 1-800-273-8255 or visit their website at https://suicidepreventionlifeline.org.  You can also communicate with someone via text message if you are in distress or have thoughts of suicide by texting “HOME” to 741741 (https://www.crisistextline.org) and you will be connected to a crisis counselor.

[Military-specific resources-You can also talk, text or online chat confidentially with a qualified responder, many of whom have military experience, by calling the Military Crisis Line at (<https://www.veteranscrisisline.net/ActiveDuty.aspx>).  You can also obtain additional information about available resources for coping with the stresses of military life at Military One Source (<http://www.militaryonesource.mil/>).]  

[The Trevor Project offers crisis intervention and suicide prevention to LGBTQ youth through its hotline, chat feature, and online support center.  You can call the Trevor Project to speak to a counsellor 24 hours a day 7 days a week at 1-866-488-7386.  You can also talk to a counsellor from The Trevor Project 24 hours a day 7 days a week by texting START to 678678.  You can chat with a counsellor from The Trevor Project by going to https://www.thetrevorproject.org/get-help-now/ and selecting the CHAT option in the upper right hand corner of the page.]

Please note that if your condition worsens or changes significantly, we would like to see you again.  You may return at any time if you have further concerns.  Following up with your primary care provider and/or specialist as indicated is important for your overall health and wellness.  As discussed in the emergency department prior to discharge, by signing these discharge instructions you are agreeing with this safety plan and agree to return if you have worsening thoughts of suicide or any other safety concerns.

Note: There are differing opinions on the utility of a safety contract in suicidal patients.  ACEP provides some templates for developing a safety contract and safety plan at this website: https://www.acep.org/patient-care/iCar2e/.

It will come down to provider preference whether you use this document as a safety contract, but there are resources where patients can obtain emergency counseling nationwide that are helpful to provide on discharge.

https://www.healthline.com/health/mental-health/suicide-resource-guide#4